分類: 不孕症新知

 

粒線體(有如細胞的電池)

[O – 116]年齡在胚胎發育的相關下降可以逆轉的粒線體代謝活化的小鼠模式

澳大利亞阿德萊德大學，阿德萊德

目的：年齡在胚胎激活線粒體的新陳代謝下，提高胚胎發育和生存能力，因此妊娠成功。
設計：越來越多的婦女延遲生育，但是女人年齡的增加而生育率下降。在過去 10年中已經出現了懷孕率顯著改善試管嬰兒，但是這一增長幾乎完全是年輕婦女改善的結果。從中年婦女的卵母細胞線粒體活性降低，導致在胚胎發育和活力減少。因此，我們假設歲的胚胎治療與線粒體代謝的刺激會顯著改善線粒體的健康，因此，提高胚胎發育。
材料和方法：瑞士小鼠年齡在24週的高齡雌性鼠超排卵，並與瑞士男性小鼠的交配。受精卵收集和分配來控制（G1/G2）或DCA（G1/G2輔以DCA130μg/ml）培養 96小時，在5％O2。胚囊的發展進行了評估 4日及5和總細胞數，ICM和外胚層發展的決心。線粒體代謝是由2 – 14C丙酮酸氧化和JC1熒光。由一般線性模型和LSD的數據進行分析。
結果：受精卵與添加DCA增加了4天，5天（P <0.05）囊胚的發展。進一步 DCA的顯著增加（P <0.05），總細胞數（133.5 ± 11.4比163.1 ± 11.8），內細胞團（23.5 ± 2.6比28.2 ± 2.8）和外胚層（6.2 ± 0.9 VS 8.2 ± 1.0）。在DCA的培養歲的胚胎在2細胞（0.21 ± 0.04比0.41 ± 0.05pmol/e/hr）丙酮酸氧化顯著增加，囊胚（0.13 ± 0.02比0.23 ± 0.03pmol/e/hr）（P < 0.01），線粒體膜電位（P <0.05）。
結論：我們已經表明，年齡受精卵培養與線粒體的刺激劑提高胚胎的代謝，增加了關鍵的發展措施，這表明，線粒體的激活可能提供了新方法提高試管嬰兒的婦女>40歲的成果。

 

陳啟煌醫師的意見:

這是我於2011年10月中旬參加美國生殖學會年會

(67th ASRM Annual Meeting, ORLANDO 2011)

比較欣賞的研究發表之一，以高齡的瑞士鼠添加粒線體的刺激劑改善胚胎品質，儘管沒有人體試驗，而從事動物實驗總在用於人之前。高齡細胞老化，粒線體老化，若能激活高齡的生物的胚胎和很多人服用健康食品希望卵及胚胎品質提升不謀而合，當然此篇並沒有展現懷孕率及活產率也是可惜。

原文

[O-116] AGE RELATED DECLINE IN EMBRYO DEVELOPMENT CAN BE REVERSED BY ACTIVATION OF MITOCHONDRIAL METABOLISM IN A MOUSE MODEL.

 

M. Lane, N. O. Palmer Discipline of Obstetrics and Gynaecology, University of Adelaide, Adelaide, SA, Australia; Repromed, Dulwich, SA, Australia

 

OBJECTIVE: To activate mitochondrial metabolism in aged embryos to improve embryo growth and viability and therefore pregnancy success.

DESIGN: Increasingly women are delaying childbearing however fertility declines as a woman ages. In the last 10 years there have been a significant improvement in pregnancy rates following IVF however this increase is almost exclusively the result of improvements for young women. Oocytes from aged women have reduced mitochondrial activity resulting in a reduction in embryo development and viability. Therefore, we hypothesised that treatment of aged embryos with a stimulator of mitochondrial metabolism would significantly improve mitochondrial health and therefore improve embryo development.

MATERIALS AND METHODS: Swiss female mice aged 24 weeks were superovulated and mated with a Swiss male. Zygotes were collected and allocated to either, control (G1/G2) or DCA (G1/G2 supplemented with 130µg/ml of dichloroacetate) and cultured for 96h in 5%O2. Blastocyst development was assessed on day 4 and 5 and total cell number, ICM and epiblast development determined. Mitochondrial metabolism was determined by 2-14C-pyruvate oxidation and JC1 fluorescence. Data was analysed by a general linear model and LSD.

RESULTS: Culture of aged zygotes with DCA increased blastocyst development on day 4 and day 5 (p<0.05). Further DCA significantly increased (p<0.05) total cell number (133.5±11.4 vs 163.1±11.8), inner cell mass (23.5±2.6 vs 28.2±2.8) and epiblast (6.2±0.9 vs 8.2±1.0). Aged embryos cultured in DCA had a significant increase in pyruvate oxidation at both the 2 cell (0.21±0.04 vs 0.41±0.05pmol/e/hr) and blastocyst (0.13±0.02 vs 0.23±0.03pmol/e/hr) (p<0.01) and mitochondrial membrane potential (P<0.05).

CONCLUSION: We have shown that aged zygotes cultured with a mitochondrial stimulant improves embryo metabolism and increased key developmental measures, suggesting that activation of the mitochondria may provide a novel method for improving IVF outcomes in women >40years.

Supported by: NHMRC

 

 

Tuesday, October 18, 2011 12:45 PM

 

生育與絕育 2011年11月22日。搶鮮版

 

 

透過Wi-Fi使用筆電上網影響精蟲質量

 

來自美國第一個試管嬰兒發源地– Eastern Virginia Medical School, Norfolk, Virginia的研究

 

摘要

 

目的：

 

為了評估筆記型電腦連接到無線局域網（WI – FI）對人類精子的影響。

 

設計：

 

在體外研究的前瞻性。

 

背景：

 

生殖醫學中心。

 

病人（S）：

 

來自29名健康捐贈者的精液樣本。

 

干預（S）：

 

由游泳活動精子被選中。每個精子懸液分為兩個等分。一個精子從每個病人（實驗）等分暴露的Wi – Fi互聯網連接的筆記本電腦4小時，而第二等份（未曝露）是不被暴露在筆記本電腦的控制，在相同條件下培養。

 

 

主要觀察指標（S）：

 

 

精子的活動力，生存能力和DNA破裂片段的評價。

 

結果：

 

捐助者的精子樣本，大多精蟲正常，暴露在4個小時的體外的無線互聯網連接

的筆記本電腦表現出顯著進步的精子活力下降，精子DNA碎片增加。死精子的水平，顯示兩組間無顯著性差異。

 

結論（S）：

 

 

據我們所知，這是第一次研究，以評估使用筆記本電腦對人類精子的直接影響。前體內的人類精子接觸到無線互聯網連接的筆記本電腦減少由非熱效應的活力和誘導的DNA碎片。我們推測，保持無線連接上互聯網圈附近的睾丸一台筆記本電腦，可能會導致男性生育能力下降。需要進一步在體外和體內研究證明這一論點。

 

陳啟煌醫師的觀點:

 

男人的精蟲標準值又下修了。世界衛生組織（WHO）最近再修正男性精蟲正常值，從每西西兩千萬隻下修到一千五百萬隻。男人的平均精蟲數在塑化劑、嗑藥、喝酒、吸菸、肥胖、生活壓力等影響下，逐年遞減。現在電磁波如影隨行在文明的進化中傷害男性。智慧型手機在腰間及口袋及筆電放在大腿上很接近睪丸的電磁波效應，可說男性透過Wi-Fi上網很愉快，也很傷害。

 

 

 

原文

Fertil Steril. 2011 Nov 22. [Epub ahead of print]

Use of laptop computers connected to internet through Wi-Fi decreases human sperm motility and increases sperm DNA fragmentation.

Avendaño C, Mata A, Sanchez Sarmiento CA, Doncel GF.

 

a	Nascentis Medicina Reproductiva, Córdoba, Argentina;
b	CONRAD, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia

 

Source

Nascentis Medicina Reproductiva, Córdoba, Argentina;

Abstract

OBJECTIVE:

To evaluate the effects of laptop computers connected to local area networks wirelessly (Wi-Fi) on human spermatozoa.

DESIGN:

Prospective in vitro study.

SETTING:

Center for reproductive medicine.

PATIENT(S):

Semen samples from 29 healthy donors.

INTERVENTION(S):

Motile sperm were selected by swim up. Each sperm suspension was divided into two aliquots. One sperm aliquot (experimental) from each patient was exposed to an internet-connected laptop by Wi-Fi for 4 hours, whereas the second aliquot (unexposed) was used as control, incubated under identical conditions without being exposed to the laptop.

MAIN OUTCOME MEASURE(S):

Evaluation of sperm motility, viability, and DNA fragmentation.

RESULT(S):

Donor sperm samples, mostly normozoospermic, exposed ex vivo during 4 hours to a wireless internet-connected laptop showed a significant decrease in progressive sperm motility and an increase in sperm DNA fragmentation. Levels of dead sperm showed no significant differences between the two groups.

CONCLUSION(S):

To our knowledge, this is the first study to evaluate the direct impact of laptop use on human spermatozoa. Ex vivo exposure of human spermatozoa to a wireless internet-connected laptop decreased motility and induced DNA fragmentation by a nonthermal effect. We speculate that keeping a laptop connected wirelessly to the internet on the lap near the testes may result in decreased male fertility. Further in vitro and in vivo studies are needed to prove this contention.

 

 

出處:第一名的不孕症期刊 Hum Reprod Update.

 

May 19, 2012搶鮮版

 

來自英國的研究

 

 

 

 

試管嬰兒IVF / ICSI治療後單胞胎妊娠其產科的結果：系統性回顧和綜合分析

 

背景

早些時候評論IVF / ICSI治療的懷孕有較高的風險相關建議。然而，最新進展，在做IVF / ICSI治療的方式，導致體外受精/ ICSI的單胞胎妊娠是否具有較高的周產期風險相關的一些爭議。本系統研究的目的是比較IVF / ICSI治療後出生的與自然受孕出生的單胞胎產科的結果。

目的

由兩位作者進行了廣泛的搜索方法。該協議同意先驗。其次PRISMA的指導。在2×2表中提取數據。使用匯集的數據，計算風險率和風險差異。質量評估研究進行批判性評價技能方案。進行敏感性分析時異質性高。

結果

有20匹配的隊列研究，包括在本次審查的10個非隊列研究。IVF / ICSI治療較自然受孕出生的單胞胎單胎妊娠的風險較高,包括（95％信賴區間）的產前出血（2.49，2.30-2.69），先天性畸形（1.67，1.33-2.09），妊娠高血壓疾病（1.49，1.39-1.59 ），早產胎膜早破（1.16，1.07-1.26），剖腹產（1.56，1.51-1.60），低出生體重（1.65，1.56-1.75），周產兒死亡率（1.87，1.48-2.37），早產（1.54，1.47 -1.62），妊娠糖尿病（1.48，1.33-1.66），引產（1.18，1.10-1.28）和胎齡小（1.39，1.27-1.53）。

結論

與自然受孕相比，相關結論顯示IVF / ICSI治療後單胞胎妊娠產科和周產期併發症的風險較高。還需要進一步研究，以確定這方面的輔助生殖技術帶來最危險和如何可以盡量減少這種風險。

 

 

Human Reproduction Update, Vol.18, No.5 pp. 485–503, 2012

Advanced Access publication on May 19, 2012 doi:10.1093/humupd/dms018

Obstetric and perinatal outcomes in singleton pregnancies resulting from

IVF/ICSI: a systematic review and meta-analysis

Shilpi Pandey1, Ashalatha Shetty2, Mark Hamilton1,

Siladitya Bhattacharya3, and Abha Maheshwari3,*

1Assisted Reproduction Unit, Aberdeen Maternity Hospital , Aberdeen AB25 2ZL , UK 2Aberdeen Maternity Hospital , Aberdeen AB25 2ZL,

UK 3Division of Applied Health Sciences, University of Aberdeen , Aberdeen Maternity Hospital , Aberdeen AB25 2ZL , UK

*Correspondence address. E-mail: abha.maheshwari@abdn.ac.uk

Submitted on February 3, 2012; resubmitted on March 30, 2012; accepted on April 14, 2012

BACKGROUND Earlier reviews have suggested that IVF/ICSI pregnancies are associated with higher risks. However, there have been recent advances in the way IVF/ICSI is done, leading to some controversy as to whether IVF/ICSI singletons are associated with higher perinatal risks. The objective of this systematic review was to provide an up-to-date comparison of obstetric and perinatal outcomes of the singletons born after IVF/ICSI and compare them with those of spontaneous conceptions. METHODS Extensive searches were done by two authors. The protocol was agreed a priori. PRISMA guidance was followed. The data were extracted in 2 × 2 tables. Risk ratio and risk difference were calculated on pooled data using Rev Man 5.1. Quality assessment of studies was performed using Critical Appraisal Skills programme. Sensitivity analysis was performed when the heterogeneity was high (I(2) > 50%). RESULTS There were 20 matched cohort studies and 10 unmatched cohort studies included in this review. IVF/ICSI singleton pregnancies were associated with a higher risk (95% confidence interval) of ante-partum haemorrhage (2.49, 2.30-2.69), congenital anomalies (1.67, 1.33-2.09), hypertensive disorders of pregnancy (1.49, 1.39-1.59), preterm rupture of membranes (1.16, 1.07-1.26), Caesarean section (1.56, 1.51-1.60), low birthweight (1.65, 1.56-1.75), perinatal mortality (1.87, 1.48-2.37), preterm delivery (1.54, 1.47-1.62), gestational diabetes (1.48, 1.33-1.66), induction of labour (1.18, 1.10-1.28) and small for gestational age (1.39, 1.27-1.53). CONCLUSIONS Singletons pregnancies after IVF/ICSI are associated with higher risks of obstetric and perinatal complications when compared with spontaneous conception. Further research is needed to determine which aspect of assisted reproduction technology poses most risk and how this risk can be minimized.

地中海飲食就是謹慎飲食

Prudent diet=謹慎飲食

 

 

 

Hum Reprod. (搶鮮版) 出處:第二名的不孕症期刊

 

Advance Access published August 11, 2012

 

 

青年男子的飲食習慣和精液質量

 

來自美國哈佛大學與羅切斯特大學的研究

 

研究的問題：不同的飲食模式與年輕男性精液質量有關嗎？

答案：謹慎的飲食習慣具有較好的精子快速活動力，但和精子濃度與型態無關。“西方”的飲食習慣模式則無關於精液分析的係數改變。

什麼是已知：在過去的幾十年裡，一直在精子和飲食質量的同時下降的證據。但飲食成分是否影響精液的質量，還有很多的未知。

研究設計，大小，持續時間：羅切斯特大學年輕男性的研究（188人）之間進行的橫截面研究。2009年和2010年在美國羅切斯特大學。參與者，設置，方法包括：男性，年齡18-22歲，這一分析。通過飲食進行了評估食物頻率確定了因子分析問卷和飲食模式。線性回歸的方法來分析的飲食方式之間的關係和傳統的精液質量參數（精子密度，活力和形態進步的）調整禁慾時間，多種維生素使用，種族，吸煙，BMI，研究期間，中度至劇烈的運動和總熱量攝入。
確定了因素分析的結果：兩種飲食模式。 “西方”模式的特點是攝入量高的紅色和加工肉類，精緻的穀物，比薩，零食，高能量飲料和糖果。 “謹慎” 飲食模式的特點是魚的攝入量高的，雞，水果，蔬菜，豆類和粗糧。謹慎的飲食呈現較好的精子快速活動力正相關％逐步游動的精子在多變量模型（P-trend=0.04的趨勢）。在最高四分位數的謹慎飲食男性高11.3％（95％CI為1.3，21.3）％逐步活動精子與男性相比，在最低四分位數。謹慎的模式是精子的濃度和形態無關。西方的模式是不相關的任何精液參數。

 

陳醫師的評論: 多吃天然食品，減少吃精緻加工飲食有助於精子快速活動力

 

 

Hum. Reprod. Advance Access published August 11, 2012

Dietary patterns and semen quality in young men

1Department of Nutrition, Harvard School of Public Health, Boston, MA, USA 2Division of Preventive Medicine and Public Health, University

of Murcia School of Medicine, Murcia, Spain 3Department of Obstetrics and Gynecology, School of Medicine, University of Rochester,

Rochester, NY, USA 4Department of Preventive Medicine, Mount Sinai School of Medicine, New York, NY, USA 5Department of

Epidemiology, Harvard School of Public Health, Boston, MA, USA 6Channing Division of Network Medicine, Department of Medicine,

Brigham and Women’s Hospital and Harvard Medical School , Boston , MA , USA

*Correspondence address. Harvard School of Public Health, Building II 3rd Floor, 655 Huntington Avenue, Boston , MA 02115 , USA .

Tel: +1-704 737-3314; E-mail: agaskins@hsph.harvard.edu

Submitted on April 13, 2012; resubmitted on June 13, 2012; accepted on July 11, 2012

 

study question: Are different dietary patterns associated with semen parameters in young men?

study answer: The consumption of a Prudent dietary pattern was significantly associated with higher progressive sperm motility and

unrelated to sperm concentration and morphology. The consumption of a Western dietary pattern was unrelated to conventional semen

quality parameters.

what is known already: Over the past decades there has been evidence of a concomitant decline in sperm and diet quality. Yet

whether diet composition influences semen quality remains largely unexplored.

study design, size, duration: The Rochester Young Men’s Study (n  188) was a cross-sectional study conducted between

2009 and 2010 at the University of Rochester .

participants, setting, methods: Men aged 18–22 years were included in this analysis. Diet was assessed via food frequency

questionnaire and dietary patterns were identified by factor analysis. Linear regression was used to analyze the relation between diet patterns

and conventional semen quality parameters (sperm concentration, progressive motility and morphology) adjusting for abstinence time, multivitamin

use, race, smoking status, BMI, recruitment period, moderate-to-intense exercise and total calorie intake.

results: Two dietary patterns were identified by factor analysis. The ‘Western’ pattern was characterized by high intake of red and processed

meat, refined grains, pizza, snacks, high-energy drinks and sweets. The ‘Prudent’ pattern was characterized by high intake of fish,

chicken, fruit, vegetables, legumes and whole grains. The Prudent pattern was positively associated with percent progressively motile

sperm in multivariate models (P-trend= 0.04). Men in the highest quartile of the Prudent diet had 11.3% (95% CI 1.3, 21.3) higher % progressively

motile sperm compared with men in the lowest quartile. The Prudent pattern was unrelated to sperm concentration and morphology.

The Western pattern was not associated with any semen parameter.

生育與絕育搶鮮版  2012年8月24日  來自美國的研究。

不孕症第三名的期刊

 

 

冷凍胚胎植入與新鮮週期胚胎植入相比顯

 

著降低子宮外孕的的發生率。

 

內華達大學醫學院婦產科系，內華達州的拉斯維加斯，內華達

 

州的拉斯維加斯，。

 

目的：
比較冷凍胚胎植入與新鮮週期胚胎植入後子宮外孕(EP）的發病率。

設計：
回顧性隊列研究。

單位：
私人生育中心。

病人（S）：
這項回顧性研究在8年的研究期間2004-2011包括2,150的囊胚植入，包括1,460新鮮囊胚植入和690 (day 1 2PN)冷凍胚胎解凍後培養至囊胚植入。

介入治療（S）：
無。

主要觀察指標（S）：
可視化的EP和處理持久性不明位置妊娠。

結果（S）：
子宮外孕在懷孕的新鮮囊胚植入為1.5％，(day 1 2PN)冷凍胚胎解凍後培養至囊胚植入子宮外孕為0。在這兩個群體治療的持續性不明位置妊娠率分別為2.5％和0.3％，分別為，此差異也有統計學意義（相對危險度為7.3，95％可信區間為1.7-31.0）。

結論（S）：
冷凍胚胎解凍後培養至囊胚植入與新鮮週期新鮮囊胚植入相比顯著降低子宮外孕的的發生率。

 

 

Fertil Steril. 2012 Aug 24. [Epub ahead of print]

Frozen-thawed embryo transfer is  associated with a significantly reduced incidence of ectopic pregnancy.

Shapiro BS, Daneshmand ST, De Leon L, Garner FC, Aguirre M, Hudson C.

Source

Fertility Center of Las Vegas, Las Vegas, Nevada; Department of Obstetrics and Gynecology, University of Nevada School of Medicine, Las Vegas, Nevada.

Abstract

OBJECTIVE:

To compare the incidence of ectopic pregnancy (EP) after fresh ET and thawed ET.

DESIGN:

Retrospective cohort study.

SETTING:

Private fertility center.

PATIENT(S):

This retrospective study included 2,150 blastocyst transfers, including all 1,460 fresh autologous blastocyst transfers and all 690 transfers of autologous blastocysts derived from post-thaw extended culture of thawed bipronuclear oocytes in the 8-year study period 2004-2011.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Visualized EP and treated persistent pregnancy of unknown location.

RESULT(S):

The rate of visualized EP was 1.5% in pregnancies in fresh autologous cycles, which was significantly more than the rate of 0 with autologous post-thaw extended culture. The rates of treated persistent pregnancy of unknown location were 2.5% and 0.3% in these two groups, respectively, a difference that was also statistically significant (relative risk 7.3, 95% confidence interval 1.7-31.0).

CONCLUSION(S):

Relative to fresh transfer, thawed ET was associated with significantly reduced incidence of EP. These findings are consistent with ovarian stimulation increasing the risk of EP.

期刊出處: 生殖生物醫學在線。 2012年07月08日。搶鮮版

 

先前週期IVF的流產對反覆IVF失敗的婦女在未來週期繼續妊娠是一個積極的預測因子

以色列的研究
摘要

人工生殖治療的婦女中妊娠且早期流產是很常見的，但它是否是一個成功在隨後的IVF週期的預後因素還不夠清楚。本研究的目的是，以確定是否有生化妊娠（BP）或自然流產（SA）會影響下一個週期的懷孕率。經歷6678次1998年1月和2010年3月的2687名婦女進行了一項回顧性研究。每個週期的持續妊娠率（PR）相比，患者在他們輔助生殖治療的婦女中妊娠早期流產過與β-HCG顯示未懷孕的流產之間。正在進行的懷孕率的影響因素進行多因素分析。 BP和/或SA的前三個週期沒有顯著改變受孕的機會（16.9％的患者BP和/或SA在上個週期，與16.5％的患者以前沒有懷孕）。從週期4開始，輔助生殖治療的婦女中妊娠早期流產的族群有更好的持續妊娠率（PR）（23.0％和11.2％，P <0.001）相關聯的前一流產的存在下（無論是BP或SA）。最後，BP和/或SA的前一循環中出現在隨後的週期中在重複IVF失敗的患者中的成功是一個積極的標記。在這個充滿挑戰組的患者，這些結果應作進一步調查。治療與輔助生殖治療的婦女在懷孕前三個月流產是常見的，但其意義還不夠健全關於未來繼續妊娠的機會。本研究的目的是確定是否在一個試管嬰兒週期，妊娠早期流產的影響正在進行的懷孕率在IVF週期。 1998年1月和2010年3月接受6678 IVF週期的2687名婦女進行了一項回顧性研究。患者在他們以前的IVF週期與懷孕的流產無法受孕的患者（HCG顯示沒懷孕）在其以前的IVF週期持續的懷孕率進行了比較。多因素分析因素對正在進行的懷孕率的影響，包括年齡，移植胚胎數的和不育的病因進行。在前三IVF週期，我們發現，妊娠早期流產的機會懷孕（懷孕率：16.9％，與上一週期相比，16.5％的患者在前面，誰也無法想像在妊娠早期流產的患者沒有顯著改變週期）。由週期4起，以前的早期流產的存在提供更好的持續的懷孕率（23.0％比11.2％，P <0.001）。總之，先前週期早期流產出現在隨後的週期在重複IVF失敗的患者成功是一個積極的標誌。

陳醫師的意見:

反覆IVF失敗者若有早期流產，第四個月起懷孕率會增加，華人社會流產後很重視調理或吃月子餐，三個月後再戰IVF持續妊娠率至活產顯著增加。

Reprod Biomed Online. 2012 Jul 8. [Epub ahead of print]

Previous abortion is a positive predictor for ongoing pregnancy in the next cycle in women with repeated IVF failures.

Haas J, Lerner-Geva L, Yerushalmi GM, Maman E, Yinon Y, Baum M, Hourvitz A.

Source

IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center , Tel-Hashomer, affiliated to the Sackler School of Medicine, Tel-Aviv University , Tel-Aviv , Israel .

Abstract

Early pregnancy loss is common among women treated with assisted reproduction treatment, but whether it is a prognostic factor for success in subsequent IVF cycles is not well established. The aim of this study was to determine whether a biochemical pregnancy (BP) or spontaneous abortion (SA) affects the pregnancy rates in the following cycle. A retrospective study of 2687 women undergoing 6678 cycles between January 1998 and March 2010 was performed. Ongoing pregnancy rate (PR) per cycle was compared between patients with a pregnancy loss versus a negative β-HCG in their previous cycles. Multivariate analysis of factors affecting ongoing pregnancy rate was performed. BP and/or SA in the first three cycles did not significantly alter the chances to conceive (16.9% patients with BP and/or SA in the previous cycle versus 16.5% patients with no previous pregnancy). From cycle 4 onwards, the presence of a previous abortion (either BP or SA) was associated with better ongoing PR (23.0% versus 11.2%, P<0.001). In conclusion, BP and/or SA in a previous cycle appears to be a positive marker for success in subsequent cycles in patients with repeated IVF failures. These results should be further investigated in this challenging group of patients.

 

Human Reproduction. 2012年9月11日 (搶鮮版)

出處:第二名的不孕症期刊

來自哈佛大學的研究

 

重度肥胖和受精失敗的卵子其特點之間的關聯

 

研究問題：是對嚴重肥胖患者（BMI≥35 kg/m²）與在患者正常的體重指數(BMI 18.5-24.9）沒有受精失敗的卵子其特點之間相比。

結論: 重度肥胖和受精失敗的卵子其卵子內紡錘體及染色體異常的機會有統計意義的高於正常的體重指數(BMI 18.5-24.9）沒有受精失敗的卵子

 

陳醫師的評論:重度肥胖不利懷孕,多運動及減肥是必要的。

 

原文

 

Hum Reprod. 2012 Sep 11. [Epub ahead of print]

The association between severe obesity and characteristics of failed fertilized oocytes.

Machtinger R, Combelles CM, Missmer SA, Correia KF, Fox JH, Racowsky C.

SourceDepartment of Obstetrics, Gynecology and Reproductive Biology, Brigham & Women’s Hospital and Harvard Medical School, 75 Francis Street, ASB 1 + 3, Rm 082, 02115 Boston, MA, USA.

 

Abstract

STUDY QUESTION: Is the cytoskeletal and chromosomal organization of failed fertilized oocytes from severely obese patients (BMI ≥ 35 kg/m(2)) altered compared with that in patients with normal BMI (BMI 18.5-24.9 kg/m(2))? SUMMARY

 

ANSWER: Compared with normal BMI patients, severe obesity was associated with a greater prevalence of spindle anomalies and non-aligned chromosomes in failed fertilized oocytes. WHAT IS KNOWN AND

 

WHAT THIS PAPER ADDS: Obesity is associated with poor reproductive outcomes, but little is known regarding the underlying mechanisms. To address potential mechanisms, our study compared the cytoskeletal and chromosome organization in failed fertilized oocytes from severely obese and normal BMI patients.

 

DESIGN: The study population was drawn from IVF patients treated in a hospital-based infertility clinic between February 2010 and July 2011. The prevalence of meiotic spindle and chromosome alignment anomalies in failed fertilized oocytes from patients with severe obesity (i.e. Class II and III; BMI 35.0-50.1 kg/m(2)) was compared with those from patients with normal BMI (BMI 18.5-24.9 kg/m(2)). Oocytes were fixed and then labeled for tubulin, actin and chromatin. Spindle number and integrity, as well as chromosome alignment, were assessed using immunofluorescence microscopy and, in some cases, confocal microscopy. Generalized estimating equations were applied, which account for the correlation among oocytes from the same patient to estimate odds ratio (OR), 95% confidence intervals (CIs) and two-sided Wald P-values. Models were adjusted for continuous age at cycle start, cycle type (IVF or ICSI) and polycystic ovarian syndrome (PCOS) a priori.

 

PARTICIPANTS AND SETTING: University-affiliated infertility clinic. A total of 276 oocytes that failed to fertilize from 137 patients were evaluated: 105 oocytes from severely obese women (n = 47) and 171 oocytes from normal BMI patients (n = 90). MAIN RESULTS AND THE ROLE OF CHANCE: (i) Significantly more oocytes from the severely obese group exhibited two spindles compared with those from the normal BMI group (58.9 versus 35.1%; OR = 2.68, CI = 1.39-5.15, P-value = 0.003).(ii) Among oocytes with a single spindle, those from severely obese patients showed a significantly higher prevalence of disarranged spindles with non-aligned chromosomes compared with those from normal BMI patients (28.6 versus 8.6%; OR = 4.58, CI = 1.05-19.86, P-value = 0.04). BIAS, CONFOUNDING AND OTHER REASONS FOR CAUTION: Inclusion of only failed fertilized oocytes, small sample size, unknown factors such as non-PCOS comorbidity. GENERALIZABILITY TO OTHER

 

POPULATIONS: For this study, by design, it is unclear whether the findings are generalizable to successfully fertilized oocytes, and whether this oocyte-level influence of obesity is generalizable to infertile women who do not undergo stimulation or, more broadly, to spontaneous conceptions in fertile women. STUDY FUNDING/COMPETING INTEREST(S): none.

 

TRIAL REGISTRATION NUMBER: n/a.

回應動人的求子故事-30的一篇權威的不孕期刊

 

生育與絕育。 2011年4月，95（5）:1773-6。
患者無法經陰道超音波濾泡穿刺取卵與卵巢的患者行經腹部超音波濾泡穿刺取卵。

 

美國哈佛大學的研究。

抽象
目的：探討患者無法經陰道超音波濾泡穿刺取卵與卵巢的患者行經腹部超音波濾泡穿刺取卵。

設計：回顧性病例對照研究。

背景：大學醫院為基礎的體外授精（IVF）診所。

病人（S）：69名婦女接受經腹部卵泡穿刺取卵，包括12例的混合腹部/陰道卵泡穿刺取卵，與對照的年齡，卵泡數，和程序進行標準的相比，。

介入治療（S）：無法透過標準的經陰道抽吸時經腹部超音波濾泡穿刺取卵一個或多個卵巢的卵泡穿刺。

主要觀察指標（S）：總和的成熟的卵母細胞，損壞的卵母細胞，受精率，胚胎數量和質量，以及臨床和正在進行的懷孕率。

結果（S）：雖然腹部卵泡穿刺取卵取得較少的卵母細胞，但發現損壞的卵母細胞，受精率，胚胎的數量和質量，或懷孕率，但差異無統計學意義。在12年的經驗，僅一個併發症需要住院治療。

（S）結論：這項研究表明，經經腹部超音波濾泡穿刺取卵是安全和有效的，產生顯著的的卵巢位移，通常位於正常位置的卵巢的婦女，經陰道抽吸取得的成果與婦女的臨床結果。當卵巢顯著的卵巢位移(如大肌腺瘤及嚴重沾黏)無法經陰道超音波濾泡穿刺取卵改採陰道經腹部超音波濾泡穿刺是應該的選擇。

 

 

原文摘要

 

Fertil Steril. 2011 Apr;95(5):1773-6.

Transabdominal follicular aspiration for oocyte retrieval in patients with ovaries inaccessible by transvaginal ultrasound.

 

Barton SE, Politch JA, Benson CB, Ginsburg ES, Gargiulo AR.

SourceDivision of Reproductive Medicine, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.

 

Abstract

OBJECTIVE: To investigate the efficacy of ultrasound-guided transabdominal follicular aspiration when the ovaries are not accessible transvaginally.

 

DESIGN: Retrospective case-control study.

 

SETTING: University-hospital based in vitro fertilization (IVF) clinic.

 

PATIENT(S): 69 women undergoing transabdominal follicular aspiration for oocyte retrieval, including 12 cases of mixed abdominal/vaginal aspiration, compared with controls matched by age, follicle number, and year of procedure undergoing standard transvaginal aspiration.

 

INTERVENTION(S): Transabdominal follicular aspiration when one or more ovaries could not be retrieved via standard transvaginal aspiration.

 

MAIN OUTCOME MEASURE(S): Total and mature oocytes retrieved, damaged oocytes, fertilization rate, embryo number and quality, and clinical and ongoing pregnancy rates.

 

RESULT(S): Cases of transabdominal aspiration had slightly fewer oocytes retrieved, but no statistically significant differences were found for damaged oocytes, fertilization rates, embryo number and quality, or pregnancy rates. In 12 years, one complication requiring hospitalization was noted.

 

CONCLUSION(S): This study demonstrates that transabdominal ultrasound-guided follicular aspiration is safe and efficacious, yielding clinical results in women with significant ovarian displacement, comparable with results achieved by transvaginal aspiration in women with normally positioned ovaries. Transabdominal ultrasound-guided aspiration should be the modality of choice when the ovaries are not accessible transvaginally.

 

白藜蘆醇(Resveratrol)在小鼠和大鼠實驗、抗癌、 消炎、 已報告改善子宮內膜異位症，血糖降低和其他有益的心血管作用。今年美國生殖醫學會年(2012, San Diego)由加州大學UC Davis分校發表白藜蘆醇(Resveratrol)在大鼠實驗對多囊性卵巢症候群的雄性素過強的狀態有改善。

參考資料Supplement to Fertility Sterility  Vol. 98 No. 35

Septermber 2012 (O-214)

出處:第一名的不孕症期刊   Hum Reprod Update. 2013年1月搶鮮版

 

老化的卵巢和子宮：新生物的見解。
SM尼爾森，安德森，特爾弗EE RA。
SourceSchool醫學，格拉斯哥大學西部醫院，格拉斯哥，英國。

摘要

 

背景:

高齡產婦與生育能力下降和不良妊娠結局。該評論詳細介紹最近的事態發展，在我們的理解中的生物學和機制，婦女和生殖衰老，生育和懷孕的影響。有關人口學，流行病學，臨床和生物學的研究方法社會學的網上圖書館（IBSS，SocINDEX），醫學和谷歌學術搜索，關鍵詞和層次醫學主題詞。在此，我們確定，側重於重點課題，它被認為有臨床相關的進展，卵巢和子宮老化的理解與改進的診斷和新的干預影響。最近被執行的結果映射的卵巢儲備功能(AMH)，卵泡動態和相關的生物標誌物，在整個生殖壽命。現在可評估環境，生活方式和產前暴露於濾泡動態，並確定其影響生殖細胞的漏洞期間的影響，也可促進早期識別個人與生殖壽命較短。如果婦女選擇到時候他們的家庭根據自己的卵巢儲備，這將重新定義計劃生育的意義。儘管最近報告的可能存在的幹細胞可被用於恢復原始卵泡，從而卵母細胞池，目前女性生殖老化的治療干預仍然有限。產婦高齡化蛻膜和胎盤發育的不利影響，這可能與反复暴露於性激素，並強調的高齡化與不良生產結局相關。結論高齡化具有無可爭議的卵巢和子宮的不利影響。卵巢老化，將有利於我們更好地了解早期識別個人最大的風險，和新的治療干預措施。在卵巢和子宮的變化除了與年齡有關的疾病，這有協同作用，減少的概率成功懷孕的結果。

 

陳醫師的意見: 晚婚及高齡求孕人口激增,卵巢及子宮的老化影響妊娠後的產科的負面結局，應審慎面對生育的規化，儘管人工生殖，借卵及代孕是不得已的手段，未婚凍卵(social egg freezing)也方興未艾，防患晚婚及高齡求孕時卵巢及子宮的老化，造成產科的悲劇。

 

原文

 

Hum Reprod Update. 2013 Jan-Feb;19(1):67-83. doi: 10.1093/humupd/dms043. Epub 2012 Oct 26.

The ageing ovary and uterus: new biological insights.

Nelson SM, Telfer EE, Anderson RA.

Source

School of Medicine , University of Glasgow , McGregor Building , Floor 2, Western Infirmary, Glasgow , UK .

Abstract

BACKGROUND Advanced maternal age is associated with reduced fertility and adverse pregnancy outcomes. This review details recent developments in our understanding of the biology and mechanisms underlying reproductive ageing in women and the implications for fertility and pregnancy. METHODS Sociological online libraries (IBSS, SocINDEX), PubMed and Google Scholar were searched for relevant demographic, epidemiological, clinical and biological studies, using key words and hierarchical MeSH terms. From this, we identified and focused on key topics where it was judged that there had been clinically relevant advances in the understanding of ovarian and uterine ageing with implications for improved diagnostics and novel interventions. RESULTS Mapping of the ovarian reserve, follicular dynamics and associated biomarkers, across the reproductive lifespan has recently been performed. This now allows an assessment of the effects of environmental, lifestyle and prenatal exposures on follicular dynamics and the identification of their impact during periods of germ cell vulnerability and may also facilitate early identification of individuals with shorter reproductive lifespans. If women choose to time their family based on their ovarian reserve this would redefine the meaning of family planning. Despite recent reports of the potential existence of stem cells which may be used to restore the primordial follicle and thereby the oocyte pool, therapeutic interventions in female reproductive ageing at present remain limited. Maternal ageing has detrimental effects on decidual and placental development, which may be related to repeated exposure to sex steroids and underlie the association of ageing with adverse perinatal outcomes. CONCLUSIONS Ageing has incontrovertible detrimental effects on the ovary and the uterus. Our enhanced understanding of ovarian ageing will facilitate early identification of individuals at greatest risk, and novel therapeutic interventions. Changes in both ovary and uterus are in addition to age-related co-morbidities, which together have synergistic effects on reducing the probability of a successful pregnancy outcome.